This single‑center retrospective cohort evaluated whether dynamic in‑hospital changes in C‑reactive protein (CRP) are associated with 12‑month aortic outcomes in patients with acute uncomplicated Stanford type B aortic intramural hematoma (IMH).
Consecutive patients diagnosed with acute uncomplicated Stanford type B IMH at the General Hospital of Northern Theater Command between January 2020 and November 2025 were enrolled. The total cohort comprised 212 patients. Mean age was 64.3 ± 9.1 years and 66.0% (140/212) were male. The study is reported as a single‑center retrospective cohort.
The key exposure was the difference between the last and the first CRP measurement during hospitalization, denoted ΔCRP. Using the median ΔCRP value, patients were dichotomized into two equal groups: a low‑change group (ΔCRP < -0.65 mg/L) and a high‑change group (ΔCRP ≥ -0.65 mg/L), each containing 106 patients.
The primary endpoint was aortic‑related adverse events (ARAE) within 12 months. ARAE was defined as a composite of aortic‑related death, progression to penetrating aortic ulcer (PAU) or aortic dissection, and rapid progression of IMH (including marked hematoma thickening, progressive aortic dilation, signs of rupture, or uncontrollable clinical symptoms). Follow‑up at 12 months was completed for 164 patients (77.4%).
Group comparisons used appropriate tests for continuous and categorical data (tests not detailed in the abstract). Kaplan‑Meier survival curves were plotted to compare time to ARAE between groups and the log‑rank test was applied. Cox proportional hazards regression models were used to evaluate the association between ΔCRP and ARAE, adjusting for covariates in multivariable analysis. Subgroup analyses were performed stratified by sex, age (≥60 vs <60 years), body mass index (BMI ≥24 vs <24 kg/m²), smoking, drinking, hypertension, and presence of ulcer‑like projection.
Initial CRP levels differed between groups: the low‑change group had a higher first CRP (median 14.6 mg/L; interquartile range 5.2–59.2) compared with the high‑change group (median 2.6 mg/L; interquartile range 1.8–16.7), P < 0.001.
Among the 164 patients with completed 12‑month follow‑up, 68 (41.5%) experienced an ARAE. The incidence of ARAE was significantly higher in the high‑change group than in the low‑change group: 48.8% (42/86) versus 33.3% (26/78), P = 0.044. Kaplan‑Meier survival analysis demonstrated consistent separation between groups (log‑rank P = 0.022).
In multivariable Cox proportional hazards regression, ΔCRP was an independent associated factor for ARAE with a reported hazard ratio of 1.54 (95% CI 1.25–1.90, P < 0.001). The analysis indicates that a smaller decrease or an increase in CRP during hospitalization confers higher risk of the composite aortic outcome over 12 months.
Stratified analyses showed that the association between a high ΔCRP and increased risk of ARAE was statistically significant in the following subgroups: age ≥60 years, BMI ≥24 kg/m², history of smoking, and presence of hypertension (all P < 0.05). Results for other prespecified subgroups (sex, drinking, presence of ulcer‑like projection) are not detailed beyond what is reported here.
The authors conclude that in patients with acute uncomplicated Stanford type B IMH, a non‑significant decrease or an increase in CRP during hospitalization is independently associated with a higher rate of 12‑month aortic‑related adverse events. They propose that dynamic monitoring of CRP during hospitalization can help identify high‑risk patients and serve as a simple, effective tool for clinical risk stratification.
All authors declared no conflicts of interest.
All numbers, comparisons, and statistical results above are taken from the PubMed abstract of the reported study. Specifics on multivariable model covariates, exact statistical tests for baseline comparisons, details of medical or interventional therapy during hospitalization, reasons for loss to follow‑up, and full subgroup result tables were not reported in the abstract and would require consultation of the full text for those details.